Octreotide as an Adjunct to Home Parenteral Nutrition in the Management of Permanent End-Jejunostomy Syndrome

Abstract

Intravenous fluid requirements for patients with permanent end-jejunostomy syndrome often exceeds 3 L/d, making rehabilitation difficult. The effect of the somatostatin analogue, octreotide (100 μg TID, subcutaneously) in reducing requirements was measured in 10 patients established on home parenteral nutrition. After 10 days of treatment, 72-hour balance measurements demonstrated significant reductions in stomal fluid and electrolyte losses from (mean ± SE) 8.1 ± 1.8 to 4.8 ± 0.7 L/d (p < .03), sodium from 510 ± 71 to 340 ± 41 mEq/d (p < .03), chloride from 533 ± 70 to 315 ± 32 mEq/d (p < .002), and potassium from 101 ± 41 to 79 ± 34 mEq/d (p < .02), permitting an average reduction in intravenous fluid requirements of 1.3 L/d (p < .0003), 118 mEq Na⁺/d (p < .03), 41 mEq K⁺/d (p < .02), and 178 mEq Cl⁻/d (p < .01). This meant that daytime intravenous infusions could be stopped in all patients. Fecal nitrogen losses were decreased (P < .05), but overall there was no significant change in fat and caloric absorption. In addition, hormonal stimulated gastric acid and pancreatic lipase secretions were significantly reduced (p < .05). The effect was most marked in those patients with massive stomal losses and uncontrollable thirst. Continuation of treatment for more than 1 year in 8 of the patients suggested preservation of potency and good tolerance, with the possible exception of accelerated gallstone formation and subacute intestinal obstruction. In conclusion, octreotide has the potential to improve the quality of life of those end-jejunostomy syndrome patients with massive stomal losses, resistant to conventional medical treatment. (Journal of Parenteral and Enteral Nutrition 18:26–36, 1994)

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